World Hepatitis Day: July 28

By Hannah Starke, M.D., PGY1, Resident, Baylor College of Medicine, The Children’s Hospital of San Antonio

World Hepatitis Day represents a day to spread awareness of the different kinds of hepatitis infections. There are five major types of infectious hepatitis viruses – A, B, C, D and E. This blog focuses on hepatitis A and its effect on children.  

What is Hepatitis A?  Hepatitis A is an infection caused by a virus that attacks the liver and can cause lifelong problems. A person contracts hepatitis A by eating, drinking, or touching something (such as door handles or diapers) contaminated with the poop of an infected person. Childcare centers are common places that experience outbreaks.

What are the signs and symptoms of Hepatitis A?  Children exposed to hepatitis A may not experience any symptoms, but the infection can cause liver failure and other lifelong health problems.  Symptoms may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fever
  • Yellowing of the skin or eyes that can last for as long as eight weeks

Even if none of these symptoms is present, a child can carry the virus and infect others who touch anything that comes into contact with their feces.

Preventing Hepatitis A  Hepatitis A can be prevented with a routine vaccine. Children generally get the first dose at 12 months and the second dose six months after. Drinking clean water, cooking all food thoroughly, and proper and frequent hand washing can help reduce the spread of this infection.

Talk to your child’s pediatrician if you have questions about the hepatitis A vaccine. If you need to identify a doctor for your child, check out the doctors who are part of The Children’s Hospital of San Antonio Pediatric Primary Care Practice: Children’s Primary Care.

July is National Cleft and Craniofacial Awareness Month

Kristen Gill, M.D., Resident, PGY2, Baylor College of Medicine, The Children’s Hospital of San Antonio

Cleft palate, cleft lip, and craniosynostosis are among the most common types of craniofacial conditions a child may have at birth.

What is a cleft palate and a cleft lip?  A congenital abnormality, or birth defect, occurs when a baby is developing in the womb and normal growth is affected in some way. A cleft palate is a congenital abnormality that occurs very early during pregnancy when the roof of the mouth, or the palate, does not form properly. The right and left halves of the palate are supposed to meet in the middle and “glue” together when in the womb, but this does not occur. A cleft lip is a similar: it occurs when the two parts of the upper lip do not meet in the middle and do not connect properly. A baby can be born with either a cleft lip or a cleft palate or both. These can affect how a baby breathes and eats. Special bottles are sometimes needed to help the baby eat properly. About 1 out of 700 babies are born with a cleft lip with or without a cleft palate. About one out of 1,000 babies are born with just a cleft palate.

What is craniosynostosis?   When a baby is born, the skull is not completely closed together. It is made up of several puzzle pieces. You can recognize this as the baby’s soft spot on the top of their head. Over time, those puzzle pieces, or different parts of the skull, grow and fuse together. Sometimes these pieces can fuse together too early while the brain is still growing. This is called craniosynostosis. About one in 2,500 children are born with craniosynostosis

Cleft palate, cleft lip, craniosynostosis, and other craniofacial conditions can vary from minor to life threatening; nearly all require surgery to repair the abnormality. There are several reasons why these conditions occur: genetics, high blood sugar levels during pregnancy, or lack of folic acid early in pregnancy.  Sometimes we do not understand why these conditions occur. But there are ways you can decrease the risk of having a baby with a craniofacial abnormality. 

What can you do to help prevent craniofacial abnormalities?

  • Start a daily prenatal vitamin when you are considering becoming pregnant
  • If you have diabetes, control your blood sugar before and during pregnancy
  • Quit smoking
  • Avoid certain medications during pregnancy. Talk to your health care provider before starting or stopping any medications

If you have questions about craniofacial abnormalities, talk to your doctor or your baby’s health care provider. If you wish to see a craniofacial pediatric specialist, contact the Craniofacial Clinic at The Children’s Hospital of San Antonio by calling 210.704.4708.

Keep Your Kids Safe Around Water

Tracy McCallin, M.D., F.A.A.P, Emergency Physician, The Children’s Hospital of San Antonio

Did you know drowning is the second highest cause of death for children under 14 years of age, and is the leading cause of death from preventable injury in children between 1-4 years? As a pediatrician working in the pediatric emergency department for the past eight years, I treat victims of drowning every year. Seeing even one child who has drowned is one too many. Every drowning is a preventable tragedy, and as a co-author for the recent American Academy of Pediatrics (AAP) policy statement “Prevention of Drowning,” I am spreading the word on water safety to give parents the knowledge they need to keep children safe around water.

Another fact you may not know is that toddlers are at highest risk of drowning during non-swim times. The biggest risk to these young children is unexpected access to water, including swimming pools, hot tubs and spas, bathtubs, toilets, and natural bodies of water. The Consumer Product Safety Commission (CPSC) reports 69 percent of children under 5 were not expected to be at or in the pool at the time of a drowning incident. Developmentally, toddlers and preschoolers are curious and lack the awareness of the dangers of water. Drowning is quiet and can take less than a minute. By the time a parent realizes the child has slipped away and fell into a backyard pool, pond or other body of water, it is often too late.

Physical barriers must be in place to prevent unintended access of children to water during non-swim times. Based on the most current evidence, installing four-sided fencing (at least 4 feet high) with self-closing and self-latching gates that completely separates the pool from the house and yard is the most effective way to prevent drowning in young children, preventing more than half of swimming-pool drownings in this age group. These safeguards are vitally important in preventing access to the water when a parent is distracted by other children, making dinner or answering the phone.

The AAP also recommends doing a “walk through” whenever you take your child to a new environment such as a friend or neighbor’s home or a vacation rental, to check for bodies of water and what barriers may or may not be in place to protect your child.

Close, constant, and attentive supervision is a critical layer of protection against drowning when children are expected to be around the water. Adults should provide “touch supervision” within arm’s reach of all children in or near the water by designating a “water watcher” who will take on this task. The watcher needs to be free from distraction including talking on the cell phone, social media and alcohol use. For infants and children up to age 6 years, always supervise when bathing and never leave a younger child in the care of an older child. Remember that children can drown in less than one minute in two inches of water or less; the time it takes for a parent to answer the door, check on dinner or get a towel. Parents should also know that teenagers are the group at second highest risk of drowning, and should be counseled about alcohol use around the water and life jacket use when boating.

Another strategy that may decrease drowning risk, which is now recommended by the AAP, is swim lessons beginning at 1 year of age. The decision of when to start swim lessons must be personalized for each child, considering your child’s comfort in the water, overall health status, developmental stage, emotional maturity, and physical ability. The AAP policy statement recommends infants younger than 1 year are developmentally unable to learn the complex movements, such as breathing, needed to swim. While they may show reflexive swimming movement under water, they cannot lift their heads well enough to breathe and there is no current evidence to suggest a benefit of infant swimming programs under 1 year of age.

Other ways to prevent drowning include wearing U.S. Coast Guard approved life jackets when boating and for non-swimmers or young children when in or near water. The AAP advises everyone should have CPR training and learn basic swimming skills, as well as swimming at sites with lifeguards especially for open water recreation.

There has been much fear, confusion and misinformation in the media during recent years about something called ‘’dry drowning” or “secondary drowning.” One of my jobs as a pediatrician doing drowning prevention work is to help worried families understand what drowning is and what it is not. Although you have likely read some scary stories out there, let me reassure you there is no such thing as dry drowning or secondary drowning. These are not actual medical conditions and the AAP recommends using the terms “nonfatal drowning” to describe a child who did not die from a drowning event, and “fatal drowning” to describe a death from drowning.  

Current evidence has shown children with a drowning event will have symptoms such as trouble breathing or lethargy within one to two hours of the event. Drowning does not occur at a later time in children who had previously looked well. Incidents where a “dry drowning” death was reported in the media were most likely a coincidental event later thought to be related to water exposure days or a week before. If your child has no problems one to two hours after coughing, sputtering or swallowing water, you can feel reassured they will not develop symptoms of a drowning event at a later time.

So when do you need to worry if your child has drowned? Based on American Heart Association (AHA) recommendations, if your child needed any type of rescue breathing or CPR at the scene of a drowning event, they should always be taken to the emergency department (ED) for evaluation. If your child is having trouble breathing or other serious problems after a drowning, he or she will need to stay in the hospital for specialized care and treatment. However, if your child is looking well with normal vital signs and exam after observation in the ED, he or she can be safely sent home and will not suffer a drowning related death days or a week later.

The best way to keep your child safe around the water is to remember there is no single way to “drown-proof” a child, and multiple layers of protection must be used against drowning. You now have the knowledge you need to keep your child and other important children in your life safe, so please share this information with others.

For more information on drowning prevention, please visit the AAP Drowning Prevention Campaign toolkit at

Also, you can visit the AAP site for parent education at to read helpful articles on water safety such as:

Learn about the signs and symptoms of Congenital CMV

Jonathan Crews, MD, MS, Pediatric Infectious Diseases, Baylor College of Medicine, The Children’s Hospital of San Antonio

Cytomegalovirus (CMV) is the most common viral cause of birth defects in the United States. About one out of every 200 babies is born with a CMV infection – when this happens, we call it “congenital CMV.” About four out of five babies born with congenital CMV are born healthy without any signs of disease (asymptomatic congenital CMV). About one out of five babies will have birth defects or other long-term health problems (symptomatic congenital CMV).

Babies with congenital CMV that are sick at birth can have a small head size (microcephaly), seizures, rash, lung disease, or a large liver and spleen (hepatosplenomegaly). Hearing loss can occur. Some babies born with asymptomatic congenital CMV can still have or develop hearing loss. Congenital CMV is the leading non-genetic cause of hearing loss in newborns in the US.

Testing can be done from a baby’s saliva, urine, or blood within two to three weeks after birth to confirm congenital CMV. Babies with signs congenital CMV should be tested. Testing should be done on all babies diagnosed with hearing loss. Babies with symptomatic congenital CMV can benefit from antiviral medicines. These medicines can lessen the severity of the hearing loss and long-term health problems, but require close monitoring with a physician due to potential side effects.

CMV is transmitted through body fluids, including urine and saliva. Pregnant women who have or work with young children (especially those in group daycare settings) are at risk of getting the infection. There are several things you can do to help prevent getting CMV during pregnancy. Wash your hands regularly – especially before and after feeding children; and before and after changing diapers. Avoid sharing food, utensils, drinks, or straws. Do not share a toothbrush or put a pacifier in your mouth.

Although CMV is common and serious, many people do not know about it. To learn more about congenital CMV, visit these websites:

Centers for Disease Control and Prevention (

National CMV Foundation (

Congenital CMV Foundation (

National Congenital CMV Disease Registry (

If you are concerned about your baby having congenital CMV, talk to your pediatrician. If you need to identify a pediatrician for your baby, please visit